Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use

Ho Suk Kang, Kang Moon Lee, Dae Bum Kim, Ji Min Lee, Yoon Jae Kim, Hyuk Yoon, Hyun Joo Jang, Ja Seol Koo

Research output: Contribution to journalArticle

Abstract

BACKGROUND Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients. AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients. METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval. RESULTS The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75 th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916). CONCLUSION A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.

Original languageEnglish
Pages (from-to)989-1001
Number of pages13
JournalWorld Journal of Gastroenterology
Volume25
Issue number8
DOIs
Publication statusPublished - 2019 Jan 1

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Ulcerative Colitis
Tumor Necrosis Factor-alpha
Republic of Korea
Delayed Diagnosis
History
Hemorrhoids
Ambulatory Care Facilities
Diagnostic Errors
Inflammatory Bowel Diseases
Medical Records
Smoking
Incidence

Keywords

  • Anti-tumor necrosis factor alpha
  • Diagnostic delay
  • Smoking
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use. / Kang, Ho Suk; Lee, Kang Moon; Kim, Dae Bum; Lee, Ji Min; Kim, Yoon Jae; Yoon, Hyuk; Jang, Hyun Joo; Koo, Ja Seol.

In: World Journal of Gastroenterology, Vol. 25, No. 8, 01.01.2019, p. 989-1001.

Research output: Contribution to journalArticle

Kang, Ho Suk ; Lee, Kang Moon ; Kim, Dae Bum ; Lee, Ji Min ; Kim, Yoon Jae ; Yoon, Hyuk ; Jang, Hyun Joo ; Koo, Ja Seol. / Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use. In: World Journal of Gastroenterology. 2019 ; Vol. 25, No. 8. pp. 989-1001.
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abstract = "BACKGROUND Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients. AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients. METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval. RESULTS The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75 th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95{\%} confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95{\%}CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95{\%}CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95{\%}CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95{\%}CI: 1.006-4.916). CONCLUSION A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.",
keywords = "Anti-tumor necrosis factor alpha, Diagnostic delay, Smoking, Ulcerative colitis",
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T1 - Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use

AU - Kang, Ho Suk

AU - Lee, Kang Moon

AU - Kim, Dae Bum

AU - Lee, Ji Min

AU - Kim, Yoon Jae

AU - Yoon, Hyuk

AU - Jang, Hyun Joo

AU - Koo, Ja Seol

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients. AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients. METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval. RESULTS The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75 th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916). CONCLUSION A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.

AB - BACKGROUND Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients. AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients. METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval. RESULTS The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75 th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916). CONCLUSION A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.

KW - Anti-tumor necrosis factor alpha

KW - Diagnostic delay

KW - Smoking

KW - Ulcerative colitis

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